Clinical Lab 2.0 Workshop to Gather Healthcare Stakeholders for a Discussion of COVID-19 and How Medical Laboratories Can Add More Value

This fourth edition of the annual event will be held virtually with free registration for pathologists and clinical laboratory professionals In its fourth year, stakeholders in the clinical laboratory community have promoted thought leadership around the Lab Industry at the Project Santa Fe Foundation’s Clinical Lab 2.0 Workshop. Clinical Lab 2.0 (CL 2.0) which identifies new opportunities for medical labs to add value as the healthcare industry transitions from fee-for-service to value-based...

Whistleblower Lawsuit Alleges Massive Fraud in Cigna Medicare Advantage Plans

A former officer of a Cigna contractor claims the insurer hatched a scheme to submit invalid diagnostic codes and filed the now-unsealed qui tam action in 2017 In a case that could provide a cautionary tale for clinical laboratories, a federal whistleblower lawsuit alleges that Cigna, through its HealthSpring subsidiary, “received billions in overpayments from the federal government” in a scheme involving the insurer’s Medicare Advantage plans. The Qui tam (whistleblower) lawsuit was filed by...

HHS Office of the Inspector General Survey Reveals That Most Hospitals Ignore or Manipulate EHR Fraud Safeguards

Although most clinical laboratories and pathology groups do not use EHR systems, the OIG’s finding should alert them to possible problems with audit integrity of their clients’ EHRs Electronic Health Record (EHR) systems were supposed to prevent fraud, but a recent report from one federal agency states that the fraud safeguards built into EHR systems are not in engaged by a majority of users. Pathologists and clinical laboratory managers with the responsibility to maintain security of software...

Medicare Officials Raise Issue of Fraud as Greater Use of Electronic Health Records Increases the Number of Claims Upcoded to More Complex CPT Codes

Issue does not directly affect clinical laboratories and pathology groups, but puts spotlight on some hospitals and physicians who frequently use these codes. Could increased use of electronic health records (EHR) systems be causing more hospitals and physicians to commit fraud because of upcoding? That’s the assertion of certain federal health officials. They attribute the increased proportion of Medicare claims for more complex and more expensive services by some providers to be, in some...
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